title: Levels of health care at academic and regional hospitals in KwaZulu-Natal.
abstract: OBJECTIVE
  To assess the levels of health care based on hospital bed utilisation at seven academic and regional hospitals in KwaZulu-Natal.
  
  
  METHODS
  A prospective study. The registrar in charge of patients documented the level of care needed for each patient over 7 consecutive days. Independent assessment by consultants was used to validate the results.
  
  
  METHODS
  All wards in public sector regional and tertiary hospitals with acute general beds in Durban and Pietermaritzburg, except intensive care, coronary care and respiratory units.
  
  
  METHODS
  All inpatients present in the wards. The response rate of wards participating in the study varied between hospitals from 32% to 75%. Data on 14,858 patient days were analysed.
  
  
  METHODS
  Inpatients were classified according to levels of care based on patient days.
  
  
  RESULTS
  The proportion of patients in the tertiary (King Edward) and regional hospitals requiring levels of care below that for which the hospital was designated ranged from 54% to 72% of the patient days. Wentworth Hospital, which is a tertiary referral centre, had 30% of its patient days judged to be below the designated level. Patient days below the designated level of care for that hospital were significantly higher in tertiary than in regional hospitals (P < 0.001).
  
  
  CONCLUSIONS
  All seven hospitals admitted patients at levels of care below that for which the hospital was designated. These findings have important implications for the efficient utilisation and planning of health and hospital services, and for their evaluation and management.
authors.affiliation: Department of Community Health, University of Natal, Durban.
authors.forename: K N
authors.initials: KN
authors.lastname: Vallabhjee
authors.forename: C C
authors.initials: CC
authors.lastname: Jinabhai
authors.forename: E
authors.initials: E
authors.lastname: Gouws
authors.forename: D
authors.initials: D
authors.lastname: Bradshaw
authors.forename: K
authors.initials: K
authors.lastname: Naidoo
mesh_terms: D001509:Bed Occupancy / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006767:Hospitals, District / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D011446:Prospective Studies; D013019:South Africa; D014600:Utilization Review / Q000379:methods